National Trends in Hospital and Physician Adoption of Electronic Health Records

The chart and table reflect a combination of different measures of EHR adoption over time – “Basic” and “Certified”. The trends reflect the highest level of EHR adoption for the given year, as measured using the listed survey data sources and methodologies described below.

How do we define and measure an “EHR”?

The term “EHR” has changed in meaning over the years. In plain language, ONC defines an EHR as “a digital version of a patient’s paper chart. It contains health information collected and maintained by healthcare providers over time. It’s a comprehensive, longitudinal record of a patient’s health history, including diagnoses, lab results, medications, physician notes, and more, accessible to authorized healthcare professionals (https://healthit.gov/health-it-basics/benefits-ehrs/).”

But when we seek to track and measure EHR adoption over time, more specific, measurable definitions are used to compare adoption across health care providers. In 2008, DesRoches, et al. (https://www.nejm.org/doi/10.1056/NEJMsa0802005) published a methodology to assess the type of technology used by ambulatory providers, identifying key computerized capabilities that, if adopted together, constituted a spectrum of “EHRs”, ranging from “Basic” to “Comprehensive”. Beginning in 2008, the “Basic” EHR definition was used as a proxy to measure the percent of health care providers that used technology for a range of clinical tasks that enabled electronic capture of patient health information and the ability to order and view medications and diagnostics. In 2009, the HITECH Act created the Health IT Certification Program, and in its provisions required that technology certified as part of the Program would need to meet certain requirements as part of the “Qualified” EHR definition. This definition was adopted in Certification Program regulations as the “Base” EHR definition, a very similar set of capabilities as adopted as part of the “Basic” EHR definition in 2008. The qualified or base EHR definition would underpin EHR certification going forward, and so as the Program certified its first modules in late 2010, measurement, too, began to track provider adoption of “Certified” EHRs. So, as this quick stat visualizes, measurement of “EHR adoption” has evolved as statutory definitions, data collection, and technology have evolved, combining the different measures into a single trend line.

See the definitions and supplementary quick stats (linked below) for more details and context.

How to interpret the hospital trend line

For the hospital trend, the “Basic EHR” measure is used for the period, 2008-2018, and the “Certified EHR” measure is used for the period, 2020-2024. Of note, the two measures – Basic and Certified – converged in 2018 (fewer than 1% of hospitals reported a Certified EHR but not an EHR that met the Basic EHR measure definition in 2018.) This mix of measures provides a composite snapshot of EHR adoption that we believe provides the highest level of EHR adoption and technology advancement across these years. In some years, especially in years prior to 2014, the adoption of “Any EHR” may be higher but does not reflect fully electronic capabilities for patient access, health information exchange, and clinical documentation – all essential components of the “Basic” and “Certified” EHR definitions.

See the complete “Non-Federal Acute Care Hospital EHR Adoption” quick stat (https://healthit.gov/data/quickstats/non-federal-acute-care-hospital-electronic-health-record-adoption) for full reporting of these separate EHR measures over time and additional context for this measurement.

How to interpret the physician trend line

For the office-based physician trend, the “Basic EHR” measure is used for the period, 2008-2014, and the “Certified EHR” measure is used for the period, 2016-2024. Of note, questions included in the National EHR Survey used to measure the “Base EHR” metric were not fielded after 2015. Beginning in 2016, the survey asked if a respondent possessed “Any EHR” and if that EHR was certified by the Department of Health and Human Services (“Certified EHR”). This mix of measures provides a composite snapshot of EHR adoption that we believe provides the highest level of EHR adoption and technology advancement across these years. In all years, the adoption of “Any EHR” is higher but does not necessarily reflect fully electronic capabilities for patient access, health information exchange, and clinical documentation – all essential components of the “Basic” and “Certified” EHR definitions.

See the complete “Office-based Physician EHR Adoption” quick stat (https://healthit.gov/data/quickstats/office-based-physician-electronic-health-record-adoption) for full reporting of these separate EHR measures over time and additional context for this measurement.

Definitions

Basic EHR: The “Basic EHR” definition was first defined in DesRoches, et al. (200), “Electronic Health Records in Ambulatory Care — A National Survey of Physicians” (https://www.nejm.org/doi/10.1056/NEJMsa0802005). Hospitals have adopted a basic electronic health record system with clinician notes when the main site of the hospital includes a computerized system with capabilities in the following areas: patient demographics, physician notes, nursing assessments, patient problem lists, electronic lists of medications taken by patients, discharge summaries, advanced directives, orders for medications, viewing laboratory results, and viewing radiology results. Physicians adopted a Basic EHR if they reported their practice performed all of the following computerized functions: patient demographics, patient problem lists, electronic lists of medications taken by patients, clinician notes, orders for medications, viewing laboratory results, and viewing imaging results.

Certified EHR: Hospitals and physicians have adopted a certified electronic health record system if the EHR technology meets the technological capability, functionality, and security requirements adopted by the Department of Health and Human Services.

Hospitals: Non-federal acute care hospital.

Office-based physicians: Office-based; principally engaged in patient care activities; non-federally employed; not in specialties of anesthesiology, pathology, or radiology; and younger than 85 years of age at the time of the survey.